Low blood pressure

Readers, especially older people, may be interested in this article about unstable blood pressure and dizziness. (Orthostatic = standing upright)

Orthostatic Hypotension in Older Adults

The prevalence was surprisingly high.

Orthostatic hypotension is common in older adults, particularly among those taking hypotensive medications and those with diseases associated with autonomic dysfunction (e.g., diabetes, Parkinson disease). In this study from Ireland, researchers used a continuous noninvasive blood pressure (BP) monitoring device to measure orthostatic change on a single occasion in 442 community-dwelling, older adults (mean age, 72).

Mean baseline supine systolic BP (SBP) was 160 mm Hg. The changes from supine to standing SBP conformed to three general patterns:

"Small drop, fast overrecovery" (25% of participants): mean SBP drop within 30 seconds, 16 mm Hg; quick recovery exceeding baseline SBP at 30 seconds
"Medium drop, slow recovery" (54% of participants): mean SBP drop within 30 seconds, 35 mm Hg; return to near-baseline SBP at 30 seconds and at 2 minutes
"Large drop, nonrecovery" (21% of participants): mean SBP drop within 30 seconds, 62 mm Hg; gradual but incomplete return to baseline SBP during 2 minutes of monitoring

Eighty-five participants met a previously published definition of "initial orthostatic hypotension" — a symptomatic SBP drop of >40 mm Hg within 15 seconds (Clin Sci (Lond) 2007; 112:157). These elders, compared with other participants, were more likely to have fallen recently (25% vs. 10%), to be taking >4 medications (54% vs. 39%), and to meet criteria for frailty or prefrailty (71% vs. 52%).

Comment: Substantial orthostatic hypotension was surprisingly common among these older people. Many had "initial orthostatic hypotension," an entity characterized by an almost immediate drop in BP that can elude detection when clinicians use conventional measuring devices. Clinically important orthostatic hypotension — both initial and delayed — almost certainly is underrecognized among older patients. Clinicians should routinely ask older patients about postural dizziness, check for orthostatic changes during office visits, and adjust medications and make other recommendations that mitigate postural BP changes.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 28, 201

Mediterranean diets

It's that time of year when thoughts naturally gravitate to the Med - sun, sea and tomatoes, aubergines, olive oil, red wine, etc.
Here's some more interesting information about all that, this time collected from the BMJ.

Salubrious Components of Mediterranean Diet Identified


A population-based cohort study in BMJ highlights the individual components of the Mediterranean diet that appear to have the greatest effect on mortality.


Researchers interviewed some 23,000 healthy Greek adults about their dietary habits and followed them for 8.5 years. They found that the following elements of the Mediterranean diet contributed the most to a mortality risk reduction:


-- moderate consumption of alcohol;
-- low intake of meat;
-- high consumption of vegetables, fruits, nuts, monounsaturated fats, and legumes.


In contrast, high intake of cereals, fish, and seafood -- and low consumption of dairy products -- showed little effect on mortality.

Statins and muscle aching

For those of you on statins, and who have suffered myalgia (muscle pain) as a result, this may be of interest. It comes from Physician's First Watch. Our patients fairly commonly complain of muscle pain or aching in the legs in particular.
Red Yeast Rice -- Treatment Option for Patients Who Can't Tolerate Statins?
Red yeast rice lowers LDL cholesterol in patients who cannot tolerate statins, reports Annals of Internal Medicine.
Some 60 patients who had discontinued statins owing to myalgia were randomized to receive red yeast rice supplements (1800 mg twice daily) or placebo for 24 weeks. (Red yeast rice contains naturally occurring lovastatin.) All patients also participated in a 12-week lifestyle change program focused on nutrition, exercise, and relaxation techniques.
Mean LDL cholesterol levels at 12 and 24 weeks fell by 27% and 21% respectively, with red yeast rice, and by 6% and 9%, respectively, with placebo. The differences between groups were statistically significant. The supplement appeared safe in terms of new-onset muscle pain, as well as creatinine phosphokinase and liver enzyme levels.
The authors acknowledge the study's limitations, including the small sample size and short duration. Still, they conclude that their intervention "may provide a therapeutic lipid-lowering option for the large cohort of patients" with statin-associated myalgia.
These are the links:
http://click.jwatch.org/cts/click?q=227%3B67221979%3BkWKrd7DBzHFe5ubIRY%2B7fMo4KRD2U6vTAlwXtPn6im4%3D
Annals of Internal Medicine editorial (Subscription required) http://click.jwatch.org/cts/click?q=227%3B67221979%3BkWKrd7DBzHFe5ubIRY%2B7fNJpnnMaymyoAlwXtPn6im4%3D
Annals of Internal Medicine patient summary (Free) http://click.jwatch.org/cts/click?q=227%3B67221979%3BkWKrd7DBzHFe5ubIRY%2B7fIrRYuze0SGdAlwXtPn6im4%3D

Ask your GP if this is relevant to you.

NICE recommendations

Readers may have noticed that the new NICE guidance for the treatment of chronic back pain on the NHS included a recommendation for manipulation or mobilisation amongst other protocols.
You can read their full guidance here.
As in all things in health care, notably when things have a cost implication, change happens slowly. So don't expect your GP practice to fund your osteopathic care just yet. But in the future, who knows... Here's hoping.
And... who knows if it helps - always ask.

Happy New Year!

A Happy New Year to all our patients and clients. And let's hope it gets warmer soon, and that we have a decent summer. Dream on....

Xmas Works Outing

Off we motored (yes, sorry - buses not too good from the Teign Valley) to Cairney's Bistro in Crediton for our Christmas do. This was a return trip, as we couldn't keep away any longer from Jim's superb cuisine.
Our pics show a fairly measured start to our celebrations (you wouldn't expect anything else -would you?) and Warwick assessing the merits of chocolate box contents. Colin's hiding behind the camera.

Fees

We usually put our fees up at this time of year to cope with landlords' requirements of yearly increases, as well as all the other bills that increase without any obvious improvement of service. But as everyone is rather overstretched this year we've decided to tighten our own belts a notch or two instead. So our fees will remain the same as last year's, at £38 for an initial consultation, with £33 for follow-ups, and a £5 discount for children and unwaged.
There are no VAT changes as you don't pay VAT on osteopathic treatment.